Dermatology

Question 1

The skin is composed of three basic layers:

Answer 1

Epidermis,
Dermis,
and Subcutaneous layers.

Question 2

The epidermis is the most superficial layer of the skin, made up of keratinized epithelial tissue, and can be further subdivided into five layers, or strata:

Answer 2

stratum Corneum, 
stratum Lucidum, 
stratum Granulosum, 
stratum Spinosum, 
and stratum Basale.

Question 3

The epidermal layer regulates __________ via the __________.

Answer 3

body temperature

autonomic nervous system

Question 4

The subcutaneous layer functions to ________ and aid in __________.

Answer 4

insulate

temperature regulation

Question 5

A change in blood flow can affect the skin’s appearance: a decrease in blood flow can cause ________, and an increase in blood flow can cause ________.

Answer 5

pallor

rubor

Question 6

Macule or patch

Answer 6

A flat lesion <1cm that cannot be palpated (primary)

Question 7

Papule

Answer 7

A solid elevated lesion or patch <1cm that can be felt (primary)

Question 8

Nodule

Answer 8

A solid mass >5mm of depth, deeper than a papule, that can be felt (primary)

Question 9

Plaque

Answer 9

An elevated, flat lesion >5mm in width (primary)

Question 10

Vesicle

Answer 10

An elevated, clear fluid filled lesion <1cm in size (primary)

Question 11

Bulla

Answer 11

An elevated, clear fluid filled lesion >1cm in size (primary)

Question 12

Pustule

Answer 12

A raised lesion comprised of purulent material that may be white, yellow, or green (primary)

Question 13

Cyst

Answer 13

Encapsulated epithelial lined cavity containing fluid (primary)

Question 14

Erosion

Answer 14

Focal, incomplete loss of dermis (primary)

Question 15

Ulcer

Answer 15

Focal, incomplete loss of dermis (primary)

Question 16

Fissure

Answer 16

Crack in the skin, often narrow and deep (primary)

Question 17

Wheal

Answer 17

Pruritic, erythematous elevated area resulting from dermal edema (primary)

Question 18

Scale

Answer 18

Dry, plate-like mass of keratin tissue (thickened stratum corneum) (secondary)

Question 19

Crust

Answer 19

Dried fluid or exudates (pus, blood, or serum) (secondary)

Question 20

Lichenification

Answer 20

Thick, rough skin with accentuated skin markings (secondary)

Question 21

Excoriation

Answer 21

Linear, traumatic lesion resulting in epidermal breakage (secondary)

Question 22

Induration

Answer 22

Dermal thickening of the cutaneous surface (secondary)

Question 23

Scar

Answer 23

Fibrous tissue that replaces normal tissue after healing (secondary)

Question 24

Blisters (friction)

Answer 24

Repetitive shearing stress in horizontal direction produces friction, soft skin
Hot spot, superficial, clear liquid,
Blister, deeper tissue, blood
Talcum powder or petroleum jelly; double socks, second skin, moleskin, ice; WEAR CORRECT SIZE SHOES

Question 25

Corns (friction)

Answer 25

Hard Corns
Caused by poor-fitting shoes or anatomical abnormalities such as hammer toes
On tops of hammer toes; appears hard and dry; sharply demarcated
Wear long enough shoes, small felt pad or sponge pad

Soft Corns
Caused by wearing narrow shoes and excessive foot perspiration
Pain lateral of the 5th toe, thick, white, macerated skin
Where wide enough shoes, keep skin dry, separate toes with cotton or lambs wool

Question 26

Intertrigo/chafing (friction)

Answer 26

Skin rubbing against itself or equipment. Irritated or eroded skin. Should be cleansed with soap and water. Reduce friction and keep the skin clean and dry. Use powder or petroleum jelly as needed.

Question 27

Acne Mechanica (friction)

Answer 27

Acne mechanica is a form of acne caused by heat, excessive pressure, and repetitive forces on the skin. Well-defined pustules and papules. Clean, dry uniforms will help reduce irritation and skin should be cleaned with soap and water immediately after activity.

Question 28

What are the 5 wound classifications?

Answer 28

Laceration
Abrasion
Avulsion
Puncture
Contusion

Question 29

Impetigo (bacterial infection)

Answer 29

Common, found in children; spreads rapidly in close contact such as wrestling
Mild itching and soreness, ruptured pustules/vesicles, honey-colored crusts
Thorough cleansing and application of topical antibacterial meds; systemic antibiotics are also appropriate

Question 30

Erysipelas (bacterial infection)

Answer 30

Face and LE bacterial skin infection that starts with a friction injury and expresses as well-demarcated, indurated, edematous, erythematous plaque. Treated with antibiotics, such as penicillin, and elevated limbs.

Question 31

Erythrasma (bacterial infection)

Answer 31

A skin infection caused by Corynebacterium minutissimum, a gram positive bacteria. It presents in skin folds as reddish-brown, pruritic, scaly plaques. Wood’s lamp, a diagnostic tool using ultraviolet (UV) light, will reveal the characteristic fluorescent coral red color of the organism. Referred to physician and topical antibiotics such as erythromycin, clarithromycin, or clindamycin.

Question 32

Folliculitis (bacterial infection)

Answer 32

A blockage of the hair follicle, only extends to the epidermis. Resolves spontaneously or may require antibiotics. Rest from shaving.

Question 33

Furuncles/carbuncles/abscess (bacterial infection)

Answer 33

More extensive than folliculitis, usually follows folliculitis. Erythematous, tender, pus-filled, elevated lesion. May include systemic sxs of fever or malaise. May be treated by warm water compresses. May require lancing and antibiotics.

Question 34

Hot tub folliculitis (bacterial infection)

Answer 34

A gram negative rod. Acquired in hot tubs, whirlpools or swimming pools that are not treated appropriately. Clears up in a week. May require antibiotics.

Question 35

Paronychia (bacterial infection)

Answer 35

Inflammation of the surrounding tissue of a nail. Treat with warm soaks with saline solution 2x daily. Topical antibacterials such as bacitracin (500 unit/g) or mupirocin 2% can be applied 2-3x daily. Antibiotics may be required, as well as incision and drainage.

Question 36

Cellulitis (bacterial infection)

Answer 36

Infection of the skin that most typically occurs after there is a break in the skin. Presents with edematous, glossy-looking, erythematous tissue that is warm and painful to the touch. Systemic manifestation is common and includes fever, chills, malaise, and myalgia.

Question 37

Acne Vulgaris (bacterial infection)

Answer 37

Inflamed hair follicles and sebaceous glands; severe acne that causes scarring
Whiteheads/blackheads, flesh- or red-colored papules, pustules, or cysts
Cleanliness c mild soap and warm water; topical and systemic meds; avoid over-treating; Accutane is effective but can cause birth defects so should be taken c contraceptive

Question 38

Hydradenitis Suppurativa

Answer 38

Non-bacterial, needs to be differentiated from acne vulgaris. In males, the perianal and but- tock areas are more commonly involved and in females, the more commonly affected areas are axial and inguinal regions. Nodules can rupture and form an abscess and eventually drain purulent material. Physician treats with anti-androgens, antibiotics, and glucocorticoids.

Question 39

Otitis Externa (swimmer’s ear)

Answer 39

Otitis externa can be caused by water polluted with the Pseudomonas bacteria. Scratching or sticking foreign objects in the ear can also lead to external otitis. Pain in the outer ear that increases when the clinician pulls on the ear.

Question 40

Methicillin-resistant Staphylococcus Aureus (MRSA)

Answer 40

It is important to distinguish between hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) and community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). Transmission occurs from skin-to-skin contact in which infected athletes transfer the bacteria to another athlete. All athletes and facilities/equipment should be kept clean.